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Regional or General Anesthesia in the Surgical Treatment of Distal Radial Fractures

A Randomized Clinical Trial

Rundgren, Johanna MD1,2; Mellstrand Navarro, Cecilia MD, PhD1,2; Ponzer, Sari MD, PhD1,2; Regberg, Alf MD2; Serenius, Stephan MD2; Enocson, Anders MD, PhD1,3

doi: 10.2106/JBJS.18.00984
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Background: Most patients undergoing surgery for the treatment of a distal radial fracture are treated in a day-surgery setting and are given either general anesthesia (GA) or regional anesthesia (RA). The main purpose of this study was to investigate the impact of the anesthesia method on patients’ postoperative opioid consumption during the first 3 days following surgery.

Methods: This was a single-center randomized clinical trial. A total of 88 patients aged 18 to 74 years who were undergoing day surgery for the treatment of a displaced distal radial fracture with volar-plate fixation were randomized to GA (n = 44) or RA with a supraclavicular brachial plexus blockade (n = 44). The primary outcome was total opioid equivalent consumption (OEC) during the first 3 postoperative days (72 hours). Secondary outcomes included OEC during days 1, 2, and 3, visual analog scale (VAS) for pain scores, maximum pain, postoperative nausea and vomiting, perioperative time consumption (surgical, preoperative, and postoperative anesthesia care time), functional outcomes, and Patient-Rated Wrist Evaluation (PRWE) and EuroQol-5 Dimensions-3 Levels (EQ-5D-3L) scores up to 6 months.

Results: The total median OEC during the first 3 postoperative days was 85 mg (range, 0 to 218 mg) in the GA group and 60 mg (range, 3 to 150 mg) in the RA group (p = 0.1). The groups differed significantly in OEC and VAS for pain scores during the first 24 hours after surgery; the median OEC was higher in the GA group before discharge (p < 0.001), while it was higher in the RA group after discharge (p < 0.001). Patients in the GA group reported more pain immediately after surgery (median score, 6; width of interquartile range [IQR], 7) and at 2 hours postoperatively (median score, 2; width of IQR, 3) compared with patients in the RA group (median score, 0; width of IQR, 0 at both time points) (p < 0.001). Maximum pain occurred at a median of 1 hour (range, 1 hour to 22 hours) after the end of surgery in the GA group compared with a median of 11 hours (range, 1 hour to 24 hours) in the RA group (p < 0.001). The total median perioperative time consumption was 244 minutes (range, 114 to 389 minutes) in the GA group compared with 146 minutes (range, 74 to 390 minutes) in the RA group (p < 0.001). There were no significant differences in functional outcomes or PRWE or EQ-5D-3L scores at 6 months.

Conclusions: The anesthesia method (GA vs. RA) significantly influenced the early patterns of postoperative pain and opioid consumption after surgical treatment of a distal radial fracture, but neither total OEC over the first 3 postoperative days nor longer-term outcomes differed between the groups.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden

2Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden

3Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

E-mail address for J. Rundgren: johanna.rundgren@sll.se

Investigation performed at the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Department of Orthopedics, Södersjukhuset, Stockholm, Sweden

Disclosure: The study was funded by a grant provided by the Stockholm County Council (ALF project, grant number 20140095). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/F291).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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